Bethlem: a famous infamous asylum

Bethlem Royal Hospital, better known as Bedlam, is universally known as the most dreadful mental asylum you can end up in. At the same time, it was the world's first hospital for the mentally ill. Time to dive into the story of this famous, yet infamous, psychiatric institution.

From Bethlem to BedlamThe institution was grounded in 1247 as a priory for the New Order of St. Mary of Bethlehem in the city London. It originally was intended as a place for the collection of alms to support the Holy Crusades, but benevolent monks would also provide housing for the poor and house the bishop, canons and brothers of Bethlehem if they visited. The priory so turned into a hospital in its British meaning: "an institution supported by charity or taxes for the care of the needy".
In the centuries that followed, the hospital slowly separated from the Order of Bethlehem. King Edward III took control over the house in the 1370s. From that moment on, the hospital lost its religious bindings, and the managers were secularized crown appointees - the master nor the inmates wore the symbolic star of Bethlehem. In 1547, Bethlem was still in possession of the crown, but its administration was granted to the city of London.
It is unsure when Bethlem began to specialize in the cure of the insane, but it is generally accepted that mentally ill resided in the house from 1377 on. From then on, Bethlem gradually converted from a general hospital to a specialized institution for the insane in 1460 - Bedlam was born.

New buildingThe original building was built over a sewer, causing overflows of waste to regularly block the entrance. Governors had noted Bedlam was filthy, but never really ordered to clean the hospital.
The first Bethlem building was very small and only had room for a dozen patients. It had been enlarged to accommodate 59 patients, but in the late 17th century, the institution moved to a new building at Moorfields, just north of the city. For the purpose of both advertising and warning, the entrance pillars held two human sculptures named 'Melancholy' and 'Raving Madness' – the former looking blank, the latter bound in chains.
Initially, the Moorfields building could accommodate 120 patients. In the first half of the 18th century, a new wing was added to be an 'incurable division', offering space for another 100 inmates. Cells were only built on one side of the building. The large and broad galleries were mainly constructed for public display.

Patients and keepersA notable share of Bedlam’s patients weren’t really mentally ill. Of course there were schizophrenics and psychopaths, but also a number of people with diseases that weren’t accepted back then, such as epilepsy, the Down syndrome or even learning disabilities. Also, people were sent there by opponents. For what is better than silencing your enemies than locking them away in a mental asylum? Even if the inmates are healthy, nobody would believe them.
The keepers of Bedlam weren't physicians originally and thus the patient's welfare wasn't their primary interest. But even if they were - at least one of the keeper-physicians, Helkiah Crooke, would keep the goods and food that were intended for patients, either for his own use or to sell it to the inmates. If the patients had nothing to trade, they often went likely to starve. This was fully according to the theory that a strict diet would heal the mad - vomiting and defecating was even aroused to "restore the body and restrain the spirits".
Crooke was dismissed in 1633, and from that point on, the management changed to a model adopted from other royal hospitals. This meant a medical regime composed of a physician, a surgeon and a apothecary. The Monro of Fyrish family produced four generations of (principle) physicians of Bedlam in the 18th and 19th century, and their regime left its mark on the conditions in Bedlam.

TreatmentsOne of the most controversial treatments was an invention by Erasmus Darwin (Charles's grandfather). The patient was bound to a chair that was swinging from the ceiling. The chair was then spun in a speed and duration as dictated by the physician. In some cases, this could go on for hours - and if it caused vomiting, this was only seen as positive.
Strict diets had always been a major way of treatment within Bedlam's history. Cold bathing was introduced in the late 17th century, and generally seen as having "an excellent effect" (according to John Monro, keeper from 1751-1791). Also bloodletting, cupping therapy, beating and emptying the body by giving the patients emetics and purgatives was believed to be effective during the Monro regime. They applied leeches for bloodletting and administered blisters.
Patients were often chained to the walls, frequently naked and starved to almost-death. One patient, James Norris, was kept in a harness for twelve subsequent years.
Consequently, many patients never left Bedlam alive. In recent years, mass graves with Bedlam’s former inmates have been uncovered in London.

Public visitingPerhaps the most dishonorable aspect of Bedlam was the fact that public with no connection to the inmates was allowed to visit. It was said that this in order to raise donations and to function as a warning, but the public did not come of the purpose of charity nor for moral lessons, but for entertainment instead. Bedlam was a human zoo, with hundreds of visitors during public holidays.